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						<h2>Ingresa tus datos</h2>
						<p class="small"><img src="img/lock.png" alt=""> Tus datos se guardarán de forma confidencial</p>
						<p><input name="name" type="text" placeholder="Nombre"></p>
						<p><input name="email" type="email" placeholder="Correo electrónico"></p>
						<p><input name="password" type="password" placeholder="Contraseña"></p>
						<p>Fecha de nacimiento</p>
						<p>
							<select name="dd">
								<option value="">Día</option>
								<option>01</option>
								<option>02</option>
								<option>03</option>
								<option>04</option>
								<option>05</option>
								<option>06</option>
								<option>07</option>
								<option>08</option>
								<option>09</option>
								<option>10</option>
								<option>11</option>
								<option>12</option>
								<option>13</option>
								<option>14</option>
								<option>15</option>
								<option>16</option>
								<option>17</option>
								<option>18</option>
								<option>19</option>
								<option>20</option>
								<option>21</option>
								<option>22</option>
								<option>23</option>
								<option>24</option>
								<option>25</option>
								<option>26</option>
								<option>27</option>
								<option>28</option>
								<option>29</option>
								<option>30</option>
								<option>31</option>
							</select>
							<select name="mm">
								<option value="">Mes</option>
								<option>01</option>
								<option>02</option>
								<option>03</option>
								<option>04</option>
								<option>05</option>
								<option>06</option>
								<option>07</option>
								<option>08</option>
								<option>09</option>
								<option>10</option>
								<option>11</option>
								<option>12</option>
							</select>
							<select name="aa">
								<option value="">Año</option>
								<option>1990</option>
								<option>1991</option>
								<option>1992</option>
								<option>1993</option>
								<option>1994</option>
								<option>1995</option>
								<option>1996</option>
								<option>1997</option>
								<option>1998</option>
								<option>1999</option>
								<option>2000</option>
								<option>2001</option>
								<option>2002</option>
								<option>2003</option>
								<option>2004</option>
								<option>2005</option>
								<option>2006</option>
								<option>2007</option>
								<option>2008</option>
							</select>							
						</p>
						<p>
							<label><input name="gen" type="radio" value="H"> Hombre</label>
							<label><input name="gen" type="radio" value="M"> Mujer</label>
						</p>
						<p><input type="submit" value="ENVIAR"></p>
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